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Syringomyelia in preterm children with posthemorrhagic occlusive hydrocephalus

Martin Weinzierl1, Dagmar Honnef, Birgit Assmann

  • 1Department of Neurosurgery, University Hospital RWTH Aachen, Aachen, Germany. mrweinzierl@me.com

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|August 2, 2012
PubMed

Insights

Posthemorrhagic hydrocephalus and syringomyelia are a rare combination in preterm infants. Prompt diagnosis and surgical intervention, such as ventriculoperitoneal shunting, can improve outcomes for this condition.

Area of Science:

  • Neonatal neurology
  • Pediatric neurosurgery
  • Developmental neurology

Background:

  • Posthemorrhagic hydrocephalus is a known complication in preterm infants.
  • The co-occurrence of syringomyelia with posthemorrhagic hydrocephalus is exceptionally rare, with limited previous reports.

Observation:

  • Two cases of preterm infants born at 27 and 28 weeks gestation presented with neonatal cerebral hemorrhages.
  • Patient 1 developed progressive ataxia, hydrocephalus, and syringomyelia at age 4 years.
  • Patient 2 was diagnosed with ventriculomegaly and syringomyelia at 4 weeks of age.

Findings:

  • Ventriculoperitoneal shunting led to clinical improvement, reduced ventricular size, and syringomyelia regression in both patients.
  • Syringomyelia appears to stem from impaired cerebrospinal fluid drainage, resolving with shunting.
  • Post-surgical bleeding complications (subdural hematoma, parenchymal hemorrhage) occurred in both cases.

Implications:

  • The association of syringomyelia with posthemorrhagic hydrocephalus may be underestimated.
  • Neurological decline in these patients warrants spinal MRI alongside cerebral imaging.
  • Careful surgical management is crucial, considering potential risks of bleeding after cerebrospinal fluid pressure reduction.
Abstract

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